Health Evaluation for Paula A Moyers

A book published in 1995, "Dressed to Kill" by Sydney Ross Singer and Soma Grismaijer appeared to show that, based on interviews with 4,730 women, the more hours each day that a woman wears a bra, the higher her risk of developing breast cancer.  "The overall increase found between 24-hour wearing and not wearing at all was 125-fold." The mechanism behind this increased risk was said to be the restricted flow of lymph fluid, which removes toxins from breast tissue, due to less breast movement and constriction caused by tight-fitting bras.

Previously, a 1991 Harvard study [Journal of Cancer and Clinical Oncology 27(2): pp131-135] found that premenopausal women who do not wear bras had half the risk of breast cancer compared with bra users.

A 2009 Chinese study [Nan Fang Yi Ke Da Xue Xue Bao 29(7): pp1451-3] found that not sleeping in a bra lowered breast cancer risk by 60%.

A 2014 study of some 1,900 women, funded by the US National Cancer Institute and published in Cancer Epidemiology Biomarkers & Prevention, however, appeared to show no increased risk at all from wearing bras among postmenopausal women, no matter how long they are worn.

It would appear that more research using a larger sample size is needed.  Meanwhile, minimizing bra use – especially when sleeping – would seem to be the safest approach to reducing risk.

Women who exercise have a lower risk of breast cancer, which could relate to better lymphatic circulation due to more breast movement.

The findings from a Danish study of more than 117,000 women confirm that height is a risk factor for breast cancer and show that it is growth in childhood that has the greatest influence.  The study, published in the New England Journal of Medicine (2004), could help explain one of the greatest puzzles of breast cancer – why the disease has seen a global increase over the previous 50 years.

An increase in milk drinking has been suggested as a factor behind the large increase in average heights in Japan.  As the Japanese adopted a more Western diet in the two decades after World War II, 12-year-old girls gained 6 inches (15cm) in height on average.  That gain has been paralleled 30 years later by a two-fold increase in breast cancer in the same generation of women.

The findings show that those women whose peak year of growth occurred between the ages of 13 and 14 had a 16% lower risk of breast cancer than those whose peak growth occurred between 10 and 11.  Girls who were tallest by the age of 14 had the highest risk.

Women with the highest intake of animal fat seem to have over a 75% greater risk of developing breast cancer.  [Journal of the National Cancer Institute 95 (2003): p.1079]

Lifetime risk for American women climbed from 1-in-12 in 1970 to 1-in-7 in 2005.

Women with 'apple-shaped' bodies may be more likely to develop breast cancer than their 'pear-shaped' counterparts.  Harvard researchers studied breast cancer risk among postmenopausal women who had never used hormone replacement therapy (HRT) and found even greater risks, with larger-waisted women appearing to be 88% more likely to develop breast cancer than smaller-waisted women.  HRT use can increase the risk of breast cancer, regardless of waist size.  Exactly why fat distribution affects breast cancer risk is not fully understood but perhaps, the researchers speculate, upper or central body fat is deeper and may be closer to the important organs and glands that regulate hormone balance than fat in the other areas of the body.  These hormonal changes may be responsible for the increased risk of the cancer.
[American Journal of Epidemiology December 1999;150: pp.1316-1324]

Risk of developing breast and colon cancers is significantly increased in those who spend a lot of time sitting, according to research presented in November of 2011 at the American Institute for Cancer Research.

One study reported that women with the highest levels of estrogen were twice as likely to develop breast cancer as those with the lowest levels.  [Journal of the National Cancer Institute, 17th April 2002]

A study published in 2003 in the Journal of the National Cancer Institute indicates that young women who eat more red meat and full-fat dairy products such as cheese may be raising their risk of breast cancer.  When comparing the women in the highest fat intake group with women in lowest intake group, those with the highest intake had a 33% greater risk of invasive breast cancer according to Eunyoung Cho of Brigham and Women's Hospital and Harvard Medical School.

Breast cancer takes years to develop, usually showing up after menopause, and factors early in a woman's life may be important.  This study is significant because it included women who had not yet reached menopause.

The study of more than 90,000 women aged 26 to 46 was taken from the Nurses' Health Study, in which volunteers answer regular questionnaires about diet and lifestyle and that data is analyzed by researchers who track the women's health.  Over the eight years of the study, 714 of the women developed invasive breast cancer.  A higher risk of breast cancer was observed among women who ate foods rich in animal fat such as red meat, cheese, ice cream and butter during their 20s, 30s and 40s.

Although it is not clear how animal fat may cause cancer, this study does indicate that there may be good reason for lowering overall animal fat intake, especially during a woman's early adult life.

One study reported that women with the highest levels of testosterone were twice as likely to develop breast cancer as those with the lowest levels.  [Journal of the National Cancer Institute, 17th April 2002]

Endometriosis has been linked to the environmental contaminant dioxin and a lack of physical activity, both of which are also associated with an increased breast cancer risk.

Based on questionnaires from 78,562 women participating in the Nurses' Health Study, reports that women who worked 30 or more years on the night shift, with at least three night shifts per month, had an almost 40% greater risk of developing breast cancer compared with those who worked the usual day shift.

A second study reports that nighttime bright light exposure is linked to increased breast cancer risk.  It is possible that exposure to more light at night – a common phenomenon in industrialized nations – may account for increased cancer risk in women, independent of night-shift work.  Another study found only a suggestion of greater risk with the brightest bedrooms, and no additional risk when turning on a light temporarily during the night.  [J Natl Cancer Ins 2001;93: pp.1557-62]

One theory is that decreased levels of the brain hormone melatonin are responsible, since this chemical is known to regulate daily sleep-wake cycles.  Previous research suggests that unusually low levels of melatonin, which can be seen if humans are exposed to light during the night, may promote tumor growth.  Normally, melatonin levels are highest during nighttime darkness and lowest during the daytime light.

The clinical experience of Dr. Pat Elliott, ND has been that a large proportion of young women with a close family history of breast cancer have low melatonin levels themselves.  One researcher noted that for breast cancer, the decline of melatonin corresponds to growth of the cancer.  This relationship is correlational, but it does suggest that there might be a causal relationship and that melatonin might fight this cancer.

A more recent study at Brigham and Women's Hospital in Boston also reported that women with the highest levels of melatonin have a breast cancer risk that is 40% lower than those with low levels of melatonin.  [Journal of the National Cancer Institute, July 2005] This new study by Dr. Schernhammer and a team at Harvard University was different in that the researchers measured levels of melatonin in the urine of women before and after they developed breast cancer.  The researchers found that melatonin levels were sharply lower in women who developed breast cancer, even well before their diagnosis.

African-Americans have higher rates of diabetes, prostate cancer, hypertension and coronary heart disease than whites.

A Harvard study found that male-pattern baldness may be a marker for increased risk of coronary heart disease.  Severe hair loss on the top of head resulted in a 36% increased risk.  The risk became lower with less hair loss.  [Archives of Internal Medicine, Jan.  24, 2001]

Tired and heavy legs may indicate that the return blood flow from the legs to the heart is impaired.  Gravity and impaired veins combined with possible heart problems result in oxygen-depletion in the legs, producing that heavy, tired feeling.

May 23, 2012: A study of approximately 24,000 people between the ages of 35 and 64 and published in the journal Heart found that participants who took regular calcium supplements were 86% more likely to have a heart attack than those who didn't take supplements.

In one study, subjects with heart disease had 10 times more fat in their stool than heart-healthy individuals.  This means those with heart disease weren't absorbing their fats [Am J Cardiology 5: p.295, 1960].

Even if you never become diabetic, high levels of insulin contribute to cardiovascular risk by increasing the process of atherosclerosis.  Insulin increases the rate at which cholesterol-laden plaque builds up on arterial walls.  The abnormally high levels of insulin produced by all overweight individuals, diabetic or not, is an independent risk factor for early cardiac death.

Cardiovascular disease is the leading cause of diabetes-related death.  People with diabetes are two to four times more likely to develop cardiovascular disease.  At least 65% of people with diabetes die from heart disease or stroke.

Not everyone with heart disease gets peripheral vascular disease, and vice versa.  For some reason, the process of atherosclerosis seems to affect different people in different places.  However, if you have one, you are definitely at increased risk for the other.

Stress may increase magnesium excretion and the resulting temporary magnesium depletion may make the heart more sensitive to electrical abnormalities and vascular spasm that could lead to cardiac ischemia.

According to Dr. Emmanuel Stamatakis of University College London's Department of Epidemiology and Public Health, the risk of heart disease and premature death from any cause increases significantly for those spending more than fours hours a day watching television, surfing the web, or playing computer games.

The study was published in the Journal of the American College of Cardiology in January of 2011 and involved 4,512 adults who were respondents of the 2003 Scottish Health Survey.  It found a 48% increased risk of all-cause mortality and an approximately 125% increase in risk of cardiovascular events among those spending more than four hours a day in front of a screen, and also suggests that even two hours of screen time each day may place someone at greater risk for a cardiac event.  The risk appears to be irrespective of factors such as smoking, hypertension, BMI, social class, and even exercise.

If you sleep less than six hours per night and have disturbed sleep you stand a 48% greater chance of developing or dying from heart disease.

While previous research has shown that depression in men and women is linked to heart disease, a recent study found that only men who are depressed face an increased risk of heart disease-related death.  [Archives of Internal Medicine, May 8, 2000)]

Obstructive sleep apnea increases a person's risk of having a heart attack or dying by 30% over a period of four to five years, according to a Yale University study presented at the American Thoracic Society 2007 International Conference in May of 2007.  Sleep apnea is associated with many physiological changes that increase the risk of both heart attack and stroke.

Some studies show that people with gum disease are more likely have heart disease than those with healthy gums.  In 2012, a scientific statement from the American Heart Association supported an association between heart disease and gum disease.

Periodontitis is a serious gum infection that damages the gums and can destroy the jawbone.  It can also lead to an increase in inflammation across the body; overactivity of inflammatory pathways is a strong risk factor for the development of atherosclerotic heart disease and heart attack.

Women with the PCOS have a five to seven times higher risk of myocardial infarction and ischemic heart disease than other women.  Surprisingly, the increased risk was found to be independent of obesity, supporting the argument that insulin resistance alone is important in determining cardiovascular risk.  [Fertil Steril 2000;73(1): pp.150-156, J Clin Endocrinol Metab 1999;84(6): pp.1897-1899]

Exercising at least four hours per week for 12 years can reduce a woman's risk of breast cancer in half, according to a study of breast cancer patients performed at the University of Southern California.  The study revealed that exercise is especially important during the adolescent and child-bearing years.  In addition, the 12 years of exercise do not need to be performed consecutively.  This study complements one performed at the Alberta Cancer Board in Alberta, Canada, which showed that exercising throughout life can cut a woman's risk of breast cancer by 20%.

A sedentary lifestyle of physical inactivity is almost as great a risk factor for heart disease as smoking because of diminished circulation and weight gain.

Research has shown that even moderate exercise can substantially reduce the incidence of coronary events.  Aerobic exercise reduces cardiac risk by lowering LDL- and raising HDL-cholesterol levels, and by reducing blood pressure, body fat, blood sugar, mental stress, and blood clotting.  Exercise also improves the heart's pumping ability, greatly enhancing the body's functional capacity and stamina.

It is never too late to start.  Healthy people who begin exercising after age 45 can reduce their death rate by 23%, and even patients who have already had heart attacks can use medically-supervised aerobic exercise to reduce their risk of another heart attack by up to 25%.

Increased physical activity lowers the risk of obesity, favorably influences the distribution of body weight and has a variety of health-related benefits, even in the absence of weight loss.  Exercise is the natural partner to weight loss.  You will discover improvement in balance, energy level, immune function, muscular strength, reflexes, and self-esteem.

Aerobic exercise reduces the risk of diabetes and improves the diabetic condition through several different mechanisms.

Regular exercise can help reduce elevated levels of hormones (such as cortisol) that are associated with chronic stress.

Regular aerobic exercise lowers fibrinogen levels – a risk factor for atherosclerosis of equal or greater predictive value than cholesterol.  Additionally, exercise improves the production of nitric oxide within the blood vessel wall, which should limit the progression of atherosclerosis.  Exercise improves the fitness of the heart as well as circulation.

Regular exercise to promote blood flow and regulation can improve low blood pressure.

Try to get at least 30 minutes of physical activity every day.

Regular aerobic exercise provides benefits for the circulatory system.

A meta-analysis of 12 separate studies comparing breast cancer risk to diet found that high consumption of fruit was associated with a 6% reduction of breast cancer compared to low consumption.

A diet high in fruits appears protective against heart disease.  The total number of deaths from cardiovascular disease was found to be significantly lower among men with high fruit consumption in one study.  A large study of male healthcare professionals found that those men eating mostly a "prudent" diet (high in fruits, vegetables, legumes, whole grains, fish, and poultry) had a 30% lower risk of heart attacks compared to men who ate the fewest foods in the "prudent" category.  A parallel study of female healthcare professionals showed a 15% reduction in cardiovascular risk when they ate a diet high in fruits and vegetables compared to the effect of a low fruit and vegetable diet.

To lose weight, you can either cut down on calorie intake by restricting the amount of food you eat, or you can transition away from eating junk food (foodstuffs long on calories but short on nutrition) toward eating food that is nutrient-dense, but relatively calorie-dilute: foods such as fruits, vegetables, beans and whole grains.

Consumption of fruits is widely accepted as lowering the risk of most common cancers except prostate cancer.  Many doctors recommend that people wishing to reduce their risk of cancer eat several pieces of fruit and several portions of vegetables every day.  Optimal intakes remain unknown.

Eating carbohydrate-containing foods, including some fruits, temporarily raises blood sugar and insulin levels.  On the other hand, a diet rich in the soluble fiber found in fruit may lower the risk of type 2 diabetes, despite the high carbohydrate content of most fruit.

High-fiber supplements, such as pectin from fruit, have been found to improve glucose tolerance in some studies.  A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long-term studies has led some researchers to question the importance of fiber in improving diabetes.  Nonetheless, most doctors advise people with diabetes to eat a diet high in fiber.  Focus should be placed on fruits, vegetables, seeds, oats and whole-grain products.

A diet high in fiber helps prevent coronary heart disease.  Eating fruits high in the soluble fiber pectin has also been linked with reduced cholesterol levels, which protects against atherosclerosis.

The fiber of choice for prevention of colorectal cancer seems to be psyllium, pectin or guar gum.  The amount of pectin in approximately two servings of fruit rich in pectin such as pears, apples, grapefruit, and oranges is 15gm.  Psyllium or guar gum are obtained by supplement.  The RDA of total fiber is 20-30gm.  In Scotland, where the average fiber intake is 2-3gm per day, there is a very high incidence of colon cancer.

For years, dietary fiber has been promoted by nutrition researchers and practitioners for colon cancer prevention.  However, in two recent studies high-fiber diets did not decrease risks of colon cancer.  The two studies are significant contributions to the literature, but they can not and do not close the discussion.  If anything, they underscore the real need for further research and analysis.

Both studies, for example, involved only short-term (four-year) adjustments to the diet.  One of them involved the use of wheat bran.  Colon cancer is a disease that can take decades to develop.  Convincing epidemiological evidence suggests that a healthy diet has its greatest preventive effect as a lifelong commitment, not a stopgap measure.  While wheat bran does not appear to provide any protective benefit, a high fruit and vegetable diet may still provide benefit in preventing colorectal cancer.

Dr. Tim Byers, M.D., M.P.H.  from the University of Colorado School of Medicine stated in the same issue of NEJM that "...observational studies around the world continue to find that the risk of colorectal cancer is lower among populations with high intakes of fruits and vegetables and that the risk changes on adoption of a different diet, but we still do not understand why." [NEJM, January 22, 1999, NEJM 342: pp.1149-55, pp.1156-62, 2000.]

In the Nurses' Health Study, beta carotene proved protective against breast cancer for more than 87,000 women.  Beta carotene both in supplement form and in foods such as fresh fruits and vegetables should be included in your diet if you are interested in breast cancer prevention.

Regarding children, plant-based diets may encourage a later menarche (beginning of the menstrual function), which has been shown to be associated with reduced risk of breast cancer in epidemiologic studies.[1, 2]

1. de Ridder CM, Thijssen JHH, Vant Veer P, et al.  Dietary habits, sexual maturation, and plasma hormones in pubertal girls: a longitudinal study.  Am J Clin Nutr 1991;54:805-13
2. Beaton GH, Bengoa JM.  WHO monograph.  1976;62:500-19

Fruits and vegetables contain antioxidant substances, such as vitamin C, vitamin E, and carotenoids, which protect cells against oxidative damage, which is related to cancer risk and other health problems.[1] The multitude of phytochemicals found in various fruits, vegetables, grains, legumes, and nuts are thought to protect against heart disease and cancer.[2]

1. Jacob RA, Burri BJ.  Oxidative damage and defense.  Am J Clin Nutr 1996;63:985S-90S
2. Craig WJ.  Phytochemicals: guardians of our health.  J Am Diet Assoc 1997;97:S199-S204

Permanent weight control is difficult to achieve.  Between 95% and 98% of repeat dieters fail, regaining the weight that they initially lose.  What about the other 2-5%? In her book "Eating Thin for Life," award winning journalist and dietician Anne Fletcher delved into the habits of a few hundred people who had not only lost an average of 64 pounds but also maintained that loss for an average of 11 years.  What did she find? "Basically, they're eating the opposite of a high-protein, low carbohydrate diet," Fletcher reported.  When she asked them to describe their eating habits, the top response was "low-fat" followed by "eating less meat." These dieters with long-term success also told her they ate "more fruits and vegetables."

Recent research supports this notion.  One research study showed that significant weight loss can be triggered by just feeding people extra fruit – 3 added apples or pears a day [Nutrition 19 (2003): p.253].  Harvard studied 75,000 women for a decade and the results suggest that the more fruits and vegetables women eat the less likely they will become obese [American Journal of Clinical Nutrition 70 (1999): p.412].  A 2004 review of the available research suggests that in general "increasing fruit and vegetable intake may be an important strategy for weight loss." [Nutrition Reviews 62 (2004): p.1]

The results of the biggest study on diet and obesity to date was released in 2003, comparing over a thousand vegans to tens of thousands of meat-eaters, and lacto-ovo vegetarians [International Journal of Obesity 27 (2003): p.728].  The meat-eaters were on average significantly heavier than the vegetarians, who were significantly heavier than the vegans.  Even after controlling for exercise and smoking and other nondietary factors, vegans came out slimmest in every age group: fewer than 2% of vegans were obese.  In a snapshot of the diets of 10,000 Americans, those eating vegetarian were slimmest whereas those eating the fewest carbs in the sample weighed the most.  [Journal of the American Dietetics Association 1010 (2001): p.411]

Researchers at the National Cancer Institute followed over 75,000 people for ten years to find out which behaviors were associated with weight loss and weight gain.  The one dietary behavior most associated with an expanding waistline was high meat consumption and the dietary behavior most strongly associated with a loss of abdominal fat was high vegetable consumption.  Even after controlling for other factors, men and women who ate more than a serving of meat per day seemed to be 50% more likely to suffer an increase in abdominal obesity than those who ate meat just a few times a week.  The researchers conclude: "Our analysis has identified several easily described behaviors [such as reducing meat intake to less than three servings per week and jogging a few hours every week] that, if widely adopted, might help reverse recent increases in adult overweight... Increases in vegetable consumption might reduce abdominal obesity even further." [American Journal of Public Health 87 (1997): p.747]

Obesity is a major contributor to many serious illnesses, and is much less common among vegetarians, compared to the general population.  Vegetarians are, on average, about 10% leaner than omnivores.

1. Pixley F, Wilson D, McPherson K, Mann J.  Effect of vegetarianism on development of gallstones in women.  Br Med J 1985;291: pp.11-2
2. Frentzel-Beyme R, Claude J, Eilber U.  Mortality among German vegetarians: first results after five years of follow-up.  Nutr Cancer 1988;11: pp.117-26
3. Melby CL, Hyner GC, Zoog B.  blood pressure in vegetarians and non-vegetarians: a cross-sectional analysis.  Nutr Res 1985;5: pp.1077-82
4. Melby CL, Goldflies DG, Hyner GC, Lyle RM.  Relation between vegetarian/nonvegetarian diets and blood pressure in black and white adults.  Am J Publ Health 1989;79: pp.1283-8
5. Sacks FM, Ornish D, Rosner B, McLanahan S, Castelli WP, Kass EH.  Plasma lipoprotein levels in vegetarians: the effect of ingestion of fats from dairy products.  JAMA 1985;254: pp.1337-41
6. Frentzel-Beyme R, Claude J, Eilber U.  Mortality among German vegetarians: first results after five years of follow-up.  Nutr Cancer 1988;11: pp.117-26
7. Burr ML, Batese J, Fehily AM, Leger AS.  Plasma cholesterol and blood pressure in vegetarians.  J Human Nutr 1981;35: pp.437-41
8. Rouse IL, Armstrong BK, Beilin LJ, Vandongen R.  Vegetarian diet, blood pressure and cardiovascular risk.  Aust NZ J Med 1984;14: pp.439-43

"35 percent of cancer deaths may be related to diet." [The National Cancer Institute booklet "Diet, Nutrition, & Cancer Prevention: A Guide to Food Choices"]

Cancer rates for vegetarians are 25 to 50% below population averages, even after controlling for smoking, body mass index, and socioeconomic status.[1,2] Vegans show even better results.  One study found that people who include generous amounts of fruits and vegetables in their daily diets have lower rates of cancers of the lung, breast, colon, bladder, stomach, mouth, larynx, esophagus, pancreas, and cervix compared to people who avoid such foods.[3]

Fruits and vegetables contain antioxidant substances, such as vitamin C, vitamin E, and carotenoids, which protect cells against oxidative damage, which is related to cancer risk and other health problems.[4] The multitude of phytochemicals found in various fruits, vegetables, grains, legumes, and nuts are thought to protect against heart disease and cancer.[5]

1. Chang-Claude J, Frentzel-Beyme R, Eilber U.  Mortality pattern of German vegetarians after 11 years of follow-up.  Epidemiology 1992;3:395-401
2. Thorogood M, Mann J, Appleby P, McPherson K.  Risk of death from cancer and ischemic heart disease in meat and non-meat eaters.  Brit Med J 1994;308:1667-70
3. Block G.  Epidemiologic evidence regarding vitamin C and cancer.  Am J Clin Nutr 1991;54:1310S-4S
4. Jacob RA, Burri BJ.  Oxidative damage and defense.  Am J Clin Nutr 1996;63:985S-90S
5. Craig WJ.  Phytochemicals: guardians of our health.  J Am Diet Assoc 1997;97:S199-S204

(Reuters, July 27, 2006) "People who ate a low-fat vegan diet, cutting out all meat and dairy, lowered their blood sugar more and lost more weight than people on a standard American Diabetes Association diet... They lowered their cholesterol more and ended up with better kidney function, according to the report published in Diabetes Care, a journal published by the American Diabetes Association."

Dr. Neal Barnard's team and colleagues at George Washington University, the University of Toronto and the University of North Carolina tested 99 people with type-2 diabetes, assigning them randomly to either a low-fat, low-sugar vegan diet or the standard American Diabetes Association diet.  After 22 weeks on the diet, 43% of those on the vegan diet and 26% of those on the standard diet were either able to stop taking some of their drugs such as insulin or glucose-control medications, or lowered the doses.  The vegan dieters lost 14 pounds (6.5 kg) on average while the diabetes association dieters lost 6.8 pounds (3.1 kg).  An important level of glucose control called a1c fell on average by 1.23 points in the vegan group and by 0.38 in the group on the standard diet.

A low-fat, low-cholesterol diet is recommended, as is an increase fiber (especially water-soluble fibers), fruits, vegetables, and vegetarian sources of protein.

Diets high in fiber-rich foods may reduce the risk of cancers of the colon and rectum.  [The National Cancer Institute booklet "Diet, Nutrition, & Cancer Prevention: A Guide to Food Choices"]

Constipation is one of the leading causes of varicose veins, although it may initially be hard to see the connection.  Constipation may restrict the blood as it returns to the torso through the deep veins in the legs.  Straining to have a bowel movement closes off these veins.  As the blood backs up it takes another course through superficial veins, thus the blue streaks in the legs.  A diet low in fat and high in fiber is best for promoting regularity: reorganize your diet to include plenty of low-fat foods, grains, fresh fruit and vegetables.  A diet tending towards vegan/raw-food generally satisfies all these requirements; vegetarians should watch their fat intake.